Just in time, Congress agreed to a one-month delay to the 23 percent cut to physicians' Medicare reimbursement scheduled to go into effect today. Of course, doctors will face a payment cut of almost 25 percent on Jan. 1 if Congress doesn't act on another postponement.

Despite the tight deadline and the holidays to work around to boot, Senate Finance Committee Chairman Max Baucus (D-Mont.) and the panel's top Republican, Charles Grassley of Iowa, have said they will try to enact a year-long patch before the short-term fix expires at the beginning of 2011. During that time, lawmakers plan to work on a long-term change to the problem.

Meanwhile, the tab for the one-month patch is expected to run $1 billion over 10 years, to be paid for by changes in Medicare reimbursement for outpatient therapy services. Long term, there's still no consensus on where the estimated $300 billion required to repeal the sustainable growth rate (SGR) formula should come from.

American Medical Association president Dr. Cecil B. Wilson applauded the short-term delay, while noting that the first baby boomers will turn 65 next year and begin relying on Medicare.

Nonetheless, some physicians have decided that the constant uncertainty is just too much to take. In Seattle, for instance, Highline Medical Group, a primary-care practice affiliated with Highline Medical Center, has issued letters to about 6,000 Medicare patients explaining that, to keep their doctors, they'll have to switch to a better-paying Medicare Advantage plan by Jan. 1.

"We really want to see patients, but we're having to ask them to get into something that will give us some kind of economic stability," Highline Medical Group's administrator, Susan Purcell, told the Seattle Times. "At some point, it's very hard to continue business."
Many other clinics have encouraged or required seniors to switch to Medicare Advantage plans, she said, "primarily due to the differential in payment."

Worried about higher out-of-pocket costs and Medicare Advantage plan solvency, patients are torn. "We're between a rock and a hard place," Theresa Duke, whose husband is on traditional Medicare and doesn't want to lose his Highline doctor, told the newspaper. Even if he switches to an Advantage plan now to keep his doctor, there's no guarantee, she says, that Highline will accept Advantage plans down the road. "Now I'm worried."

To learn more:
- read the Associated Press article in the Washington Post
- see the post in the Wall Street Journal Health Blog
- here's the piece in Healthcare Finance News
- check out this story in the Seattle Times

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Thank you, doctors, for all that you do